HIV and AIDS have reached epidemic proportions in communities of color, especially among African-Americans and Hispanics. In our HIV/AIDS Minority Trend Table section, Tables 1 and 2 show how serious the problem is. For example, while African-Americans made up 13% of the U.S. population in 2005, they were 50% of AIDS cases. For Hispanics, while they made up 14% of the U.S. population, they were 18% of AIDS cases. In other words, while African Americans and Hispanics combined made up 27% of the U.S. population in 2005, they represented 68% of all AIDS cases.

With adequate information, education, and access to high quality care, racial and ethnic minority populations can, with the help of others who care, reverse the AIDS Epidemic in communities of color. To do so, however, more targeted efforts and financial resources are necessary, given the limited resources in communities of color, and their competing needs.That’s why it is in the interest of “mainstream America” to ‘stay the course’ in supporting the fight against HIV/AIDS until it is no longer a leading national health problem.

The HIV/AIDS section of our web site provides a wide spectrum of information concerning HIV prevention, early detection and control.

“Mainstream America” should care more about the AIDS epidemic in multicultural populations because:

An increased societal investment on HIV prevention would be a very sound investment because the cost of treating HIV and AIDS is very high, and all taxpayers pay those costs, directly or indirectly;

The illnesses of some people with AIDS, combined with the general treatment and treatment monitoring needs often interfere with productivity in the workplace, whose composition is increasingly made up of multicultural populations;

More organizations and individuals who are financially able to do so will hopefully give more support to HIV prevention efforts; soon recognize the great loss to society from silently (sort of) permitting the AIDS epidemic to continue destroying so many lives; and

Treatment with medications called protease inhibitors, and the use of cocktails (multiple drug therapy) has changed AIDS from primarily being a fatal disease, to a chronic disease (that people can live with for a long time).

Therefore, we think there is still a greater need for a focus on HIV prevention, especially in economically disadvantaged high risk populations where the incidence continues to be highest.

However, once HIV or AIDS develop, ensuring access to high quality ongoing medical and ancillary care is in the best interest of those infected, their families, and society as a whole.

The Down Low (DL)

The term Down Low is most widely understood to mean keeping some information or activity private, or down low. It is also often used to describe the behavior of men who have sex with other men as well as with women, but do not consider themselves as gay or bisexual. Instead, they may refer to themselves as on the down low, on the down low, on the DL, or on the low.

Although the practices of bisexual men are not unique to African-American men, the Down Low term is probably most often used regarding African American men because it reportedly originated in the African American community. However, there is an unknown, but significant, number of Hispanic and White men who are also on the Down Low/bisexual.

While it is known that some heterosexual women have become infected with HIV through sexual contact with men who have sex with men (also called by some health agencies and others MSM), the extent of this cause is not really known. For example, some heterosexual women develop HIV infection from men who have sex with men who also inject drugs (intravenous drug users, or IVDUs).

African American, and Then Hispanic Women, are at Much Greater Risk

The extent to which African American women have sex with African American men on the Down Low may be related to the significant increase in HIV infection among them is unknown, much more research is needed regarding this issue. CDC is currently collaborating in the conduct of several projects related to HIV-related risk practices in men, including men who refer to themselves as on the Down Low.

Today, women account for one-fourth of all new HIV/AIDS diagnoses:

• Of the 126,964 women living with HIV/AIDS in 2005, 64% were African American and 15% were Hispanic;

•Further, the rate of AIDS diagnosis in African-American women was 23 times the rate in white women.

Contributing to the high incidence of HIV/AIDS in African Americans, and then Hispanic women, is the unknown but significant number of their male partners and acquaintances that also have sex with men, often without the women’s knowledge. Some of these men do no consider themselves gay or bisexual, and instead refer to themselves as on the Down Low.

The various challenges for all involved or associated with The Down Low requires that:

• African American and Hispanic women become better informed about how to protect themselves from HIV, and act on that knowledge:

• The public health community , physicians and other health professionals , and researchers give a higher priority to health education, behavioral research, and the availability of support networks and related resources, especially in high risk communities of color. Of the 207,810 men who reported having sex with men (MSM) in 2005, 32% or one-third of the total was African American and Hispanic. Further, of the MSM who reported injecting drugs, which are another major risk factor for HIV, 39% were African American and 14% were Hispanic, for a total of 44%.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health and a widely recognized HIV/AIDS expert, has noted in several interviews regarding World AIDS Day that “Complacency on AIDS is dangerous”.

Further, when asked Who is the Face of AIDS in the U.S. today? His response, in essence, was:

• A young African American woman is infected by a partner who she did not know…was infected, and had no reason to believe she needed to, or even had the means to, protect herself.

• A young African American man, who is bisexual, and because of the stigma associated with being gay, plus the stigma associated with being infected, does not seek counsel nor appreciate what he needs to do to decrease or eliminate HIV transmission.

Now, almost 50% of men with HIV/AIDS are African American, and in women, almost 60% are in African American women. See our website Health Trends by Health Power for other racial and ethnic HIV/AIDS statistics.

All women of color, especially African American women, who bear the greatest burden from HIV/AIDS, need to be well informed about The Down Low, and to increase their knowledge, skills and determination to protect themselves and their futures. Hopefully their sense of self worth will be enough to motivate them to do so. However, if not, they will hopefully do so for the good of those they love…or in the reverse, for the good of them who love them.

Participation in women’s support groups (even two people can be a group), can also help women of color better protect themselves and their futures.

On March 24th, CDC released in 2006 HIV/AIDS Surveillance Report: Cases of HIV infection and AIDS in the United States and Dependent Areas. In the report, CDC compared the number of reported cases of HIV infection in 2005 and 2006, and found a 48% increase. However, some of the increase was related to the fact that more states reported in 2006 than in 2005. More detailed information on CDC’s 2006 HIV Surveillance Report is available on the CDC web site.

AIDS & African-Americans: It’s Time for Action:
NYS Statewide Research by Health Power’s President

In 1992 and 1993, Dr. Norma Goodwin, President of Health Power, conducted an 18-month statewide strategy development action project on HIV prevention in African-Americans for the AIDS Institute of the New York State Department of Health. In addition to the AIDS Institute’s publication and wide distribution of the Final Report, it was also distributed for several years as a CDC resource of the AIDS Clearinghouse.

Key research activities were:

a comprehensive literature review,

conduct of 48 focus groups,

92 in-depth interviews,

an all-day Grassroots workshop

an all-day Leaders and Experts workshop,

analysis of selected high profile print and broadcast commercials targeting African-Americans to identify common elements.

Focus groups were conducted with the following African-American groups:

adolescents

gay and bisexual men and adolescents

heterosexual men

lesbians

prison inmates (current and former)

substance users

partners of substance users

women of childbearing age, including a Caribbean group

faith based leaders

other leaders and experts

In addition, focus groups were conducted with representatives of community based organizations.

HIV prevention strategies were developed for:

the African-American groups listed above;

African-American faith leaders and communities;

Other African-American leaders;

HIV counseling and testing;

Community organizations; and

Public communication.

Key Project Findings:

Dr. Goodwin considers many of the findings and recommendations of her research still valid, and not adequately pursued, today. They were:

Although African-Americans then knew the two most common ways HIV is transmitted – through participation in unprotected sex, and sharing of needles and other materials used in intravenous (IV) drug use – their knowledge of other modes of transmission was limited.

While many African-Americans associated having AIDS with death and with being stigmatized, relatively few were aware of the wide range of physical, psychological, social and economic consequences often encountered by people with AIDS.

Even though African-Americans were aware that, theoretically, they could develop AIDS as a result of prior or current practices – and many had friends, relatives or acquaintances who had HIV infection or had died of AIDS – they tended to disassociate this knowledge from a feeling of personal vulnerability.

Although most African-Americans who were economically disadvantaged were aware that they might be engaging in practices which put them at risk of contracting HIV/AIDS, feelings of hopelessness and low self-esteem prevented them from acting in their own best interest. In other word, there was a strong link between poverty and attitudes which contributed to the disproportionate prevalence of AIDS in African-Americans.

Many African-Americans considered institutional racism to be a major contributing factor to the disproportionately high rate of HIV/AIDS in the African-American population; some also considered AIDS a form of genocide.

Although many African-Americans stated that they would want to know if they had HIV infection, most had not received HIV counseling and testing because, among other reasons, they distrusted government and feared they would lose family, social and community relationships if they were found to be infected and their HIV status became known.

Most African-Americans felt that Black religious organizations could, and must, play a much greater role in preventing AIDS in their communities.

Many African-Americans felt that African-American leaders and organizations should be much more active in trying to prevent AIDS in their communities.

The following more detailed findings are provided in this Section of the web site:

12 Barriers to HIV/AIDS Prevention and Control in Racial/Ethnic Populations

Group-specific Barriers to HIV/AIDS Prevention & Control for:

– Gay and Lesbian Persons
– Heterosexual Men

– Heterosexual Women

– Prisoners and Parolees

– Substance Abusers

(including of Alcohol and Non-injection Drugs)

– Teenagers

– Women of Childbearing Age

Following the group-specific information provided for the above groups, Health Power provides recommendations on what communities and community groups, and faith leaders should do.

The recommendations on the web site refer to communities of color rather than just African-Americans because there is a significant correlation between socio-economic status or poverty, and the incidence of HIV/AIDS, irrespective of race and ethnicity.

This does not mean, however, that the barriers identified by Dr. Goodwin and Healrh Power apply to all people/communities of color. The latter observation is made because of the importance of avoiding stereotypes regarding African-Americans, Hispanics and other groups and sub-groups that are disproportionately affected by HIV/AIDS, given the multiple harmful effects of stereotyping.

Many improvements have occurred regarding HIV/AIDS in the 15 years since Dr. Goodwin conducted AIDS and African-Americans: It’s Time for Action. Noteworthy among these improvements has been the availability today of rapid testing methods, effective combination treatment, and capacity building within many organizations that serve African-American, Hispanic and other multicultural populations and communities.

Unfortunately, however, the lower overall socioeconomic status of African-Americans as compared to the general population means that many African-Americans with HIV/AIDS have less access to high quality care and follow-up.

What Health PowerWill Do to Help Reverse the HIV/AIDS Health Disparities in African Americans and Other People of Color

In the view of Dr. Goodwin, much too little action has been taken that is consistent with many recommendations resulting from her research. The increasing disparity regarding African-Americans and HIV/AIDS convinces her that there is a continued need for the adoption and implementation of research based strategies. Further, because of the continuum related to the various aspects of HIV/AIDS, an increased focus is needed on prevention, early detection and control.

Because Health Power considers such action still very much needed, we will periodically add more detailed findings from the AIDS and African-Americans: It’s Time for Action research to the HIV/AIDS Section of our web site. In that way, we hope to share useful information with others who want to help make a difference in eliminating the excessive burden of HIV/AIDS on African-Americans. Specifically, they will be able to select just one strategy from many, and then recruit others to join with them in actively addressing that strategy in order to help make a difference.

Soundness of This Research Project as a Basic Model for Replication

The soundness of the AIDS and African-Americans: It’s Time for Action Project is evident from a number of factors including:

Credibility of its sponsor – the New York State AIDS Institute;

Comprehensiveness of the Project design and effectiveness of its implementation;

Project focus on gathering information and advice directly from those at risk and/or affected by the HIV/AIDS epidemic.

Expertise and credibility of Project Director, staff and consultants*;

Expertise and credibility of the more than 400 participating organizational representatives and other individuals; and

Recognition of the project’s significance as reflected by wide distribution of the Final Report over a period of several years by the New York State AIDS Institute and CDC.

Dr. Goodwin has a limited number of copies of AIDS and African-Americans: It’s Time for Action that can be obtained for the cost of postage and handling, paid in advance.

* A list of the more than 400 organizations and individuals who participated in this project is provided in the Final Report.

A Special Need 15 Years Later from Health Power’s Perspective

Since health disparities regarding HIV/AIDS in African-Americans have continued to increase over the past 15 years, a comprehensive qualitative research study which has a similar design and approach to AIDS and African-Americans: It’s Time for Action is greatly needed today:

to identify those recommended organizational and community strategies that have been actively pursued, nationally, to what extent, and what the outcomes have been;

to determine changes in HIV/AIDS related the knowledge, attitudes and practices of the various population sub-groups that participated in this research project (and ideally, a number of additional population sub-groups); and

to identify key strategies needed today to reverse the damaging and increasing effect of HIV/AIDS on African-Americans because: It‘s Time for More Intensive Action.

Health Power considers it very important that a repeat research project, based on the AIDS and African-Americans: It’s Time for Action model, be conducted after updated modifications. The wide array of recommended strategies from the project, although apparently not adequately focused on in our opinion, make a strong case for comparing the findings from thatbaseline study with where we are today – both as health professionals and at-risk communities and populations.

Finally, as disturbing as the statistics and trends regarding HIV/AIDS and African-Americans are today, they are even more disturbing when one considers the fact that the statistics represent the sickness and loss of thousands of mothers, fathers, children, significant others, and families, both nuclear and extended. The net effect is also great loss to their communities, and to society as a whole.

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